Symptoms of Depression

General Symptoms

Depression affects not only the thoughts and feelings but the entire motor function. The drive is gone; the person no longer has any feeling. In the truest sense: affected individuals can no longer live.

Main Symptoms

• Depressed mood — changes little from day to day
• Loss of interest — loss of pleasure in normally enjoyable activities
• Reduced drive — leading to increased fatiguability and restriction of activity

Additional Symptoms

• Reduced concentration and attention
• Reduced self-esteem and self-confidence
• Feelings of guilt and worthlessness
• Negative and pessimistic future perspectives
• Suicidal thoughts, self-harm, or suicidal acts
• Sleep disturbances
• Reduced appetite

Description of the Condition

Complaints are as described above. Characteristic is the yawning inner emptiness, despondency, and lack of drive. In severe cases, the affected person merely lies in bed, unable to do anything of their own volition. This can also extend to speech.

Note

The drive can also be increased in the form of inner restlessness.

Typical features are:

• Feelings of meaninglessness
• A feeling of being unable to feel
• Inability to cry
• Massive self-reproach coupled with strong feelings of guilt
• “I have done everything (in life) wrong”

Suicide Risk

The self-reproach and feelings of guilt can escalate to such a degree that the affected person resorts to suicide.

Severity Levels According to ICD-10

Mild Depressive Episode

For the diagnosis of a mild depressive episode, the following are required:

• At least 2 of the 3 main symptoms
• At least 2 of the additional symptoms
• Duration: at least 2 weeks

The patient is generally still able to continue most activities of daily life.

Moderate Depressive Episode

For the diagnosis, the following are required:

• At least 2 of the 3 main symptoms
• At least 3-4 of the additional symptoms
• Duration: at least 2 weeks

The patient usually has considerable difficulty continuing everyday activities.

Severe Depressive Episode

For the diagnosis, the following are required:

• All 3 main symptoms
• At least 4 of the additional symptoms (some of which are particularly pronounced)
• Duration: at least 2 weeks (or shorter if symptoms are particularly severe)

Severe Episode

In a severe episode, continuation of social, domestic, and occupational activities is only possible to a very limited extent. Inpatient treatment is often necessary.

Atypical Presentations

In some cases, other symptoms may be in the foreground:

• Intermittent anxiety and torment
• Motor restlessness
• Irritability
• Excessive alcohol consumption
• Histrionic behaviour
• Intensification of previously existing phobic or compulsive symptoms
• Hypochondriacal ruminations

In Adolescents

An atypical presentation is particularly common in adolescence.

The Somatic Syndrome

The somatic syndrome (also called “melancholic” or “endogenous” features) encompasses:

Symptom	Description
Anhedonia	Loss of interest or loss of pleasure
Emotional unreactivity	Lack of ability to react to positive events
Early morning awakening	2+ hours before the usual time
Morning low	Worsening of mood in the morning
Psychomotor changes	Inhibition or agitation
Loss of appetite	Markedly reduced food intake
Weight loss	Often more than 5% in the past month
Loss of libido	Markedly reduced sexual interest

Diagnostic Criterion

The somatic syndrome should only be diagnosed when at least 4 of the listed symptoms are clearly identifiable.

Diagnostic Criteria

For the diagnosis of depressive episodes of all severity levels, a duration of at least 2 weeks is generally required. Shorter periods may be considered if symptoms are unusually severe or have appeared rapidly.

Important Diagnostic Considerations

When making a diagnosis, many things must be taken into account:

• Is a personality disorder present? (e.g., histrionic personalities fall ill more frequently)
• Is there psychotropic substance abuse? (alcohol, cannabis, amphetamines, painkillers, etc.)
• What was the childhood and parental home like?
• Were there traumatic experiences in the past?
• Are there social or relationship problems? (separation, loss)
• Were there previous depressive episodes?
• What is the character profile/psychogram?
• Are the hormone-producing glands in order? (thyroid diseases can cause depression)
• Are medications being taken? (e.g., contraceptive pills can trigger depression)

Exclusion Diagnoses

Dementia (F00-F03) or intellectual disability (F70-F79) do not preclude the diagnosis of a treatable depressive episode. However, due to communication difficulties, it is more necessary than usual to rely on objectively observable somatic symptoms for the diagnosis.

Most Common Exclusion Criterion

The episode is not attributable to psychotropic substance abuse (F10-F19) or an organic mental disorder (F00-F09).

Associated Terms

According to ICD-10, the following fall under depressive episodes:

• Individual episodes of depressive reaction
• Major depression (without psychotic symptoms)
• Psychogenic depression
• Reactive depression